Provider First Line Business Practice Location Address:
470 CHAMBERLAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07522-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-595-6444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2010